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At least 253 records · Page 14Linked to original sources
PubMed1999

Cholesterol in peripheral vascular disease--a suitable case for treatment?

We assessed the prevalence of conventional risk factors for ischaemic heart disease in patients with peripheral vascular disease, and the scope for preventative treatment with lipid-lowering therapy in this group, by retrospectively reviewing 299 patients who had undergone peripheral angiography in 1996. A total of 278 patients had severe peripheral vascular disease; 44% were current smokers at the time of their angiogram, and 36% had a history of coronary artery disease (either myocardial infarction, coronary artery bypass surgery, coronary angioplasty or angina). Cholesterol had been measured in 80 (27%) patients, of whom 26 (9%) were receiving treatment for hypercholesterolaemia. Patients with a history of ischaemic heart disease were more likely to have had their cholesterol measured (50% vs. 15%; p < 0.001). Hypertension (defined as systolic > 160 mmHg or diastolic > 90 mmHg) was present in 44%. There was no difference in the distribution of risk factors between those with and those without known ischaemic heart disease. There is a high prevalence of modifiable risk factors for coronary disease in patients with severe peripheral vascular disease. Effective prevention is available for coronary artery disease, but we found low levels of treatment. There is considerable scope for intervention to reduce the risk of coronary disease in such patients.

Aged↗
PubMed2005

Placental vascular disease and toll-like receptor 4 gene expression.

OBJECTIVE: Vascular disease in the placenta, which is identified by the study of umbilical artery Doppler flow velocity waveforms, is associated with endothelial cell activation and a proinflammatory cytokine response in the villous placental circulation. We studied toll-like receptor 4 expression (the ligand is lipopolysaccharide) to examine whether infection may cause these inflammatory components of placental vascular disease through an innate immune response. STUDY DESIGN: Microvessel endothelial cells were isolated from human placentae with collagenase digestion and then extracted with Dynabeads that were coated with monoclonal antibody against CD31. We studied 13 placentae from normal pregnancies that were delivered at term and 15 pregnancies with umbilical placental vascular disease that was defined by an abnormal umbilical artery Doppler study. We extracted RNA from the isolated endothelial cells. The messenger RNA expression of toll-like receptor 4 production was assessed by reverse transcriptase-polymerase chain reaction and factored relative to the glyceraldehyde-3-phosphate dehydrogenase and 18S ribosomal RNA genes. RESULTS: Microvessel endothelial cells from placental villi with placental vascular disease showed up-regulation of toll-like receptor 4 expression (toll-like receptor 4/18S, 1.92 +/- 0.37 vs 0.99 +/- 0.19; P < .05; toll-like receptor 4/glyceraldehyde-3-phosphate dehydrogenase, 2.20 +/- 0.36 vs 1.25 +/- 0.22; P < .05) in comparison with normal pregnancy. CONCLUSION: Up-regulation of toll-like receptor 4 gene in the endothelium of the placental villi is present in placental vascular disease, which may result from exposure of this endothelium to the toll-like receptor 4 ligand lipopolysaccharide in vivo. Directly extracted endothelial cells were used to avoid the possibility for change in behavior in tissue culture. We conclude that Gram-negative infection and lipopolysaccharide stimulation may cause placental vascular disease.

Adult↗
PubMed1997

Immunopathology of collagen vascular disease.

In this review, we focus on the heterogeneity of interstitial lung diseases detected in patients with collagen vascular diseases. By recognizing the heterogeneity of histopathology and comparing them with bronchoalveolar lavage fluid cell findings, we can understand profiles of lung inflammation and injuries and fibrosis in collagen vascular diseases. We focus on the significance of lung lymphocytosis in the lesions of patients with collagen vascular diseases, looking most closely at lesions in unusual interstitial pneumonia. The current understanding of immunopathogenesis and immunopathological findings is reviewed in the context of subsets of collagen vascular diseases.

Collagen Diseases↗
PubMedDate not supplied

A nurse-led clinic for patients with peripheral vascular disease.

Patients with peripheral vascular disease have complex and challenging health needs. This article describes an innovative nurse practitioner role in the provision of care for patients with intermittent claudication in an acute hospital setting. A small-scale evaluative study of patient satisfaction with the nurse consultation revealed high levels of satisfaction with the care received. It is suggested that experienced nurses can make substantial contributions to improving care for patients with chronic disease.

Aged↗
PubMedDate not supplied

Hormone replacement therapy and peripheral vascular disease in women.

Women have been shown to have a lower incidence of vascular disease when compared to men. However, the incidence of vascular disease increases as women progress through menopause and reaches an incidence similar to that of men later in life. Women with peripheral vascular disease often have a delay in diagnosis, a higher incidence of asymptomatic disease, and poorer outcome after interventions. The differences in outcome have been attributed to a number of factors such as anatomic and hormonal differences. It is thought that estrogen deficiency is at least partially responsible for the increased risk of developing vascular disease after menopause, and thus hormone replacement therapy has been considered as a method to prevent progression of vascular disease. Conclusions drawn from a number of recent studies have resulted in a divergent view of hormone replacement therapy (HRT). This article explores the risk of peripheral vascular disease in women and the current state of research on hormone replacement therapy. The aims of this review are to present current perspectives on gender differences in the pathogenesis and outcomes of peripheral arterial disease (PAD). The effect of estrogen on atherogenesis, the role it plays in modulating the vascular endothelium, and the current evidence of the effects of HRT on vascular pathology is discussed. The most recent HRT clinical trials and present evidence for the benefits and risks of postmenopausal hormone replacement therapy are summarized. The effect of these issues on treatment practices is explained and suggestions are made for future directions of HRT and PAD research.

Aortic Aneurysm, Abdominal↗
PubMed1995

[Interstitial pneumonia associated with collagen vascular diseases: histological findings, and cells in bronchoalveolar lavage fluid].

Collagen vascular diseases are systemic inflammatory disorders, and autoimmune abnormalities play an important role in their pathogenesis. The lungs are often involved and the manifestations can be quite heterogenous. Cases of interstitial pneumonia associated with collagen vascular disease must be distinguished from infection, malignancy, cardiac failure, and renal failure. The diversity of interstitial pneumonia can be seen in the results of computerized tomography and in cells found in bronchoalveolar lavage fluid (BALF). We examined the heterogeneity of interstitial pneumonia diagnosed by open lung biopsy, and evaluated the diagnostic accuracy of BALF cell findings by comparing then with results of histological studies. Three patterns of BALF cell findings were defined, and were used to study the heterogeneity of the interstitial pneumonia associated with collagen vascular diseases: sarcoidosis, usual interstitial pneumonia (UIP), and bronchiolitis obliterans organizing pneumonia (BOOP). In 36 patients with collagen vascular diseases, interstitial pneumonia was diagnosed by open lung biopsy: 15 patients had rheumatoid arthritis, 3 had systemic lupus erythematosus, 9 had systemic sclerosis, 6 had dermatomyositis/polymyositis, and 4 had Sjögren's syndrome. As disease controls, 78 patients with idiopathic pulmonary fibrosis and 12 with idiopathic BOOP diagnosed by open lung biopsy were used. BAL was done before the biopsy. In most patients, the interstitial pneumonia associated with systemic sclerosis was UIP and the BALF cell pattern was a UIP-pattern. In addition, BALF UIP-patterns were associated with histologic findings of UIP in samples obtained by open lung biopsy. In contrast, other collagen vascular diseases tended to be associated with a BALF BOOP-pattern, which included various histological findings. Thus, the BALF BOOP-pattern, is associated with BOOP, with cellular interstitial pneumonia, with lymphocytic interstitial pneumonia, and with UIP. The BALF sarcoidosis-pattern is rare in patients with interstitial pneumonia associated with collagen vascular diseases.

Adult↗
PubMed1995

Hyperhomocysteinemia and the risk for vascular disease in hemodialysis patients.

The objective of this study was to examine if hyperhomocysteinemia is associated with occlusive vascular disease in hemodialysis patients. The study design included risk factor analysis and determination of serum homocysteine in hemodialysis patients. Fifty chronic uremic patients on regular hemodialysis treatment were studied. Twenty-four patients had coronary, cerebral, or peripheral signs of occlusive vascular disease. Cerebral vascular disease was diagnosed by computed tomography, arterial angiography, or Doppler sonography of the carotid and vertebral arteries. Coronary vascular disease was diagnosed by documented history of myocardial infarction or by coronary angiography. The diagnosis of peripheral vascular disease was established by angiography of the lower limb arteries. In all control patients, Doppler sonography of the carotid, vertebral, and lower limb arteries and thallium-201 exercise imaging were without pathologic results. Measurements included blood pressure, body mass index, smoking behavior, serum homocysteine (measured by gas chromatography/mass spectrometry), serum total, low-density lipoprotein, and high-density lipoprotein cholesterol, lipoprotein (a), triglycerides, and plasma fibrinogen. In a stepwise multiple logistic regression analysis, high serum homocysteine was significantly associated with occlusive arterial disease (R = 0.23; P = 0.031). Furthermore, hypertension (R = 0.18; P = 0.058), but not serum total, low-density lipoprotein, and high-density lipoprotein cholesterol, lipoprotein (a), triglycerides, diabetes mellitus, body mass index, plasma fibrinogen, and smoking behavior, was significantly associated with atherosclerosis. Our results support the hypothesis that hyperhomocysteinemia is an independent risk factor for vascular disease in hemodialysis patients.

Adult↗
PubMed1995

Lipids and lipoprotein(a) as risk factors for vascular disease in patients on renal replacement therapy.

A large cohort of patients on renal replacement therapy were screened for the presence of symptomatic arterial disease affecting the coronary, cerebral or peripheral circulations. Ninety-two of 325 patients were found to have vascular disease. Those with vascular disease had significantly higher median lipoprotein(a) [Lp(a)] levels than those without (38.4 vs 14.2 mg/dl, P < 0.001), with a preponderance of Lp(a) levels greater than 30 mg/dl (58% vs 25% P < 0.001). Apolipoprotein(a) [apo(a)] isoform distribution was similar between the groups, but those with vascular disease had higher Lp(a) levels in the S2, S3/S4 and S4 isoform types. Comparison of 76 matched pairs of patients confirmed elevated Lp(a) levels in those with vascular disease. These patients also had significantly higher total cholesterol (6.66 vs 6.02 mmol/l) and low-density lipoprotein cholesterol (4.49 vs 3.86 mmol/l). Only Lp(a) was independently associated with vascular disease (P = 0.02). Elevated Lp(a) levels are significantly associated with the presence of vascular disease in patients on renal replacement therapy and may constitute another risk factor for the development of such disease in these patients.

Adult↗
PubMed2006

Plasma homocysteine and vascular disease in psychogeriatric patients.

BACKGROUND: There is a high frequency (40-50%) of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders, and patients with a history of vascular disease exhibit significantly higher plasma tHcy concentration than patients without vascular disease. METHOD: The main objective of the present study was to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We have therefore investigated 304 psychogeriatric patients and determined plasma tHcy and its most important determinants (folate and cobalamin status and renal function), and the natriuretic peptide N-terminal-pro brain natriuretic peptide (NT-proBNP). The patients were classified into several groups of vascular disease according to the findings of brain imaging and presence of a history/symptoms indicating manifest occlusive arteriosclerotic vascular disease. RESULTS: Plasma tHcy concentration is associated with the presence of vascular disease in psychogeriatric patients. The presence of vascular disease is also associated with higher age, higher serum NT-proBNP, renal impairment and lower serum folate concentration than in patients without vascular disease. The significant association between plasma tHcy concentration and vascular disease remained after correction for age and for cystatin C differences between the groups of patients without and with vascular disease. In the present population with only 16% of the patients showing elevated plasma tHcy, renal function was a more important determinant for plasma tHcy concentration than folate status. CONCLUSION: Plasma tHcy concentration is associated with vascular disease. In the present population of psychogeriatric patients renal function is associated with vascular disease and elevated plasma tHcy concentration. Thus, the association between plasma tHcy concentration and vascular disease might partially be explained by impairment of renal function.

Aged↗
PubMed2005

Plasma homocysteine concentration and its relation to symptoms of vascular disease in psychogeriatric patients.

BACKGROUND: There is a high frequency of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders. Psychogeriatric patients with a history of vascular disease exhibit a significantly higher plasma tHcy concentration than patients without vascular disease. METHOD: The main reason for the present study is to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We therefore investigated 152 psychogeriatric patients and determined plasma tHcy and its most important determinants (serum folate and serum cobalamin, serum cystatin C and serum creatinine). The patients were divided into two groups according to the presence of vascular disease. Eighty-seven patients had concomitant vascular disease. We also analysed the natriuretic peptide N-terminal pro brain natriuretic peptide (NT-proBNP) and protein S-100B in serum. NT-proBNP is a marker for congestive heart failure, whereas protein S-100B is a marker for brain damage. RESULTS: The plasma tHcy concentration is elevated in the presence of dementia or vascular disease in psychogeriatric patients. The presence of dementia or vascular disease is also associated with higher age, renal impairment and lower serum folate concentration than in patients without dementia or vascular disease. Furthermore, we observed elevated serum concentrations of NT-proBNP in patients with dementia or vascular disease as a sign of poorer cardiovascular status. Likewise, protein S-100B concentrations were elevated in patients with dementia or vascular disease, possibly indicating brain damage in these groups of patients. CONCLUSION: The high frequency of comorbidity of vascular disease and mental illness indicates a possibility to prevent and treat psychogeriatric disease by actively counteracting vascular disease in patients with psychogeriatric symptoms. Routine determination of NT-proBNP is valuable for obtaining information about cardiovascular status.

Aged↗
PubMed1995

Treatment of vascular disease caused by vibration.

Vascular diseases caused by vibration are treated by different methods. We ourselves applied in our patients subcutaneous injections of hot-spring gas, per os prazosin (postsynaptic blocker of alpha-sympathetic receptors) which except for its vasodilatory effect improves the rheologic qualities of blood). Subcutaneous injections of hot-spring gas were administered to 31 males aged 32 to 67 years (average 50.58 years) for 15 days, Prazosin VUFB to 12 males aged 33 to 64 years (average 47.8 years) for 28 days and pentoxifylline (Agapurin SPOFA) to 20 males aged 29 to 69 years (average 46.35 years) for 28 days. Simultaneous nervous disease caused by vibration was present in 12 patients, articular affections caused by vibration in 10 patients, and disease of peripheral nerves and joints in 16 patients. The subjective complaints were influenced mostly by hotspring gas, the cold water test by prazosin, the skin temperature and plethysmogram by pentoxifylline. When evaluating the number of favourably influenced indicators pentoxifylline is the most successful. Tolerance of all three methods proved to be good.

Adrenergic alpha-Antagonists↗
PubMed1982

Beta-adrenergic blockade and peripheral vascular disease.

Hypertension and ischaemic heart disease are common accompaniments of peripheral vascular disease, and are often treated with beta-blocking drugs. Previous reports, however, have suggested that these drugs may aggravate peripheral vascular disease. A study was designed to investigate this problem with claudication-distance and skin and muscle blood-flow studies (as determined by 133Xe clearance) as indices for assessment. In all 11 patients who presented with features of peripheral vascular disease and were found to be taking beta-blocking drugs, administration of the drug was stopped, blood pressure was controlled by other means, and the situation was reassessed four weeks later. There was a significant improvement in claudication distance and in resting and post-exercise muscle blood flow after withdrawal of the drug. This held for both cardioselective and nonselective beta-blockers. It is recommended that this group of drugs be avoided in the treatment of patients with peripheral vascular disease.

Adrenergic beta-Antagonists↗
PubMed1995

Pain, pills, and possibilities: drug therapy in peripheral vascular disease.

Currently, pharmacologic therapy offers no cures for the patient with vascular disease. Drugs are available, however, to prevent or delay the end organ damage of vascular disease, to keep vessels patent as long as possible, and to provide some relief from the pain associated with vascular disease and cell damage. In this article, the author reviews the drugs used to manage hypertension--diuretics, beta blockers, alpha adrenergic blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, antiadrenergic drugs, and nitroprusside; and drugs used to maintain vessel patency in peripheral vascular disease--peripheral vasodilators and anticoagulants; and reviews one regimen for dealing with the chronic pain of vascular disease--narcotics and tricyclic antidepressants.

Drug Monitoring↗